T2DM treatment intensification

Question 1

CV risk considerations for intensification

Answer 1

If they have existing atherosclerotic disease, CKD or HF
->60yo
-smoking
-dyslipidemia
-HTN

Question 2

Renal risk considerations for intensification

Answer 2

GFR < 60 we need to consider dose adjustments and changes
- SGLT2i lose glycemic control <45ml/min (still has renal and CV protection)

Question 3

Hyperglycemia risk considerations for intensification

Answer 3

-Lowering A1C is good but too aggressively can increase mortality, aim for target at 1 year instead
-Are they at risk of hypo events?

Question 4

Weight gain risk considerations for intensification

Answer 4

Are they ok on a drug that causes this?

Question 5

What does glucose reduction improve

Answer 5

Can improve major related events only
-CV disease
-CKD
-Blindness

Question 6

accepted CV risk increase

Answer 6

-non-inferiority boundary of HR1.3 to 1.8. If it 95% CI crosses 1.3 then approved but need for post market. if it crosses 1.8 then not approved

Question 7

MACE

Answer 7

Major adverse cardiovascular event
-heart attack
-stroke
- CV related death
-hospitlization for angina (4 point)
-hospitalization for HF (5 point)

Question 8

What improves MACE?

Answer 8

SGLT2 and GLP-1i

Question 9

What improves renal

Answer 9

SGLT2 and GLP-1i

Question 10

what improves HF

Answer 10

nothing

Question 11

what improves heart attack

Answer 11

only SGLT2 tested but does reduce outcomes (in only the highest risk patients 3% of population)

Question 12

CVOT

Answer 12

Guidelines for cardiac safety testing for diabetes drugs

Question 13

T2DM insulin initiation basal only

Answer 13

Start with 10 units for the first night and increase 1 unit every night until fasting glucose of 4-7 is achieved

Question 14

T2DM insulin initiation Basal + bolus

Answer 14

0.5u/kg/day split 40% basal and 3x20% bolus